Widespread pfhrp2/3 deletions and HRP2-based false-negative results in southern Ethiopia.

BACKGROUND: Rapid diagnostic tests (RDTs) play a significant role in expanding case management in peripheral healthcare systems. Histidine-rich protein-2 (HRP2) antigen detection RDTs are predominantly used to diagnose Plasmodium falciparum infection. However, the evolution and spread of P. falciparum parasite strains with deleted hrp2/3 genes, causing false-negative results, have been reported. This study assessed the diagnostic performance of HRP2-detecting RDTs for P. falciparum cases and the prevalence of pfhrp2/3 deletions among symptomatic patients seeking malaria diagnosis at selected health facilities in southern Ethiopia. METHODS: A multi-health facilities-based cross-sectional study was conducted on self-presenting febrile patients seeking treatment in southern Ethiopia from July to September 2022. A purposive sampling strategy was used to enroll patients with microscopically confirmed P. falciparum infections. A capillary blood sample was obtained to prepare a blood film for microscopy and a RDT using the SD Bioline™ Malaria Pf/Pv Test. Dried blood spot samples were collected for further molecular analysis. DNA was extracted using gene aid kits and amplification was performed using nested PCR assay. Exon 2 of hrp2 and hrp3, which are the main protein-coding regions, was used to confirm its deletion. The diagnostic performance of RDT was evaluated using PCR as the gold standard test for P. falciparum infections. RESULTS: Of 279 P. falciparum PCR-confirmed samples, 249 (89.2%) had successful msp-2 amplification, which was then genotyped for hrp2/3 gene deletions. The study revealed that pfhrp2/3 deletions were common in all health centres, and it was estimated that 144 patients (57.8%) across all health facilities had pfhrp2/3 deletions, leading to false-negative PfHRP2 RDT results. Deletions spanning exon 2 of hrp2, exon 2 of hrp3, and double deletions (hrp2/3) accounted for 68 (27.3%), 76 (30.5%), and 33 (13.2%) of cases, respectively. The study findings revealed the prevalence of P. falciparum parasites lacking a single pfhrp2-/3-gene and that both genes varied across the study sites. This study also showed that the sensitivity of the SD Bioline PfHRP2-RDT test was 76.5% when PCR was used as the reference test. CONCLUSION: This study confirmed the existence of widespread pfhrp2/3- gene deletions, and their magnitude exceeded the WHO-recommended threshold (> 5%). False-negative RDT results resulting from deletions in Pfhrp2/3- affect a country's attempts at malaria control and elimination. Therefore, the adoption of non-HRP2-based RDTs as an alternative measure is required to avoid the consequences associated with the continued use of HRP-2-based RDTs, in the study area in particular and in Ethiopia in general.

Prevalence of Hypertension and Its Associated Factors Among Adults Living with HIV on Antiretroviral Treatment in Selected Public Hospitals in Addis Ababa, Ethiopia.

Introduction: Hypertension significantly increases the risk of heart, brain, and renal diseases and is one of the leading causes of death and disease worldwide. It is a major comorbidity among HIV-positive people. There have been limited attempts to detect hypertension and its related variables in patients receiving antiretroviral treatment, notably in Addis Ababa, Ethiopia. The current study intended to examine the incidence of hypertension and related variables among adults aged 18 and over living with HIV on ART at selected public referral hospitals in Addis Ababa, Ethiopia. Methods: A hospital-based cross-sectional study was conducted on 411 HIV-positive individuals aged 18 on ART at Alert and St. Peter's Specialized Hospitals. The research was conducted between December 15, 2021, and January 20, 2022, using an interviewer administered standardized questionnaire. Epi-Info version 7.0 was used to enter and code the collected data, which was subsequently exported to SPSS version 23.0. Bivariate and multivariate logistic regression models were used to identify associated variables. Results: The prevalence of hypertension among people with HIV on ART was 37.5% (95% CI: 32.8-42.5). Age groups 35-50 years (AOR: 2.18; 95% CI: 1.13-4.21), alcohol consumption (AOR: 5.58; 95% CI: 2.92-10.65), no physical exercise (AOR: 2.35; 95% CI: 1.06-5.21), family history of hypertension (AOR: 4.39, 95% CI: 2.48-7.76), duration of ART (AOR: 3.13; 95% CI: 1.20-8.12), low CD4 count (AOR: 1.87; 95% CI: 1.04-3.37), and body mass index greater than or equal to 25 kg/m2 (AOR: 2.38; 95% CI: 1.33-4.25) were factors associated with hypertension among HIV patients on ART. Conclusion and Recommendation: According to this study, hypertension is prevalent in HIV-positive people. Factors related with hypertension in PLHIV include alcohol intake, lack of physical activity, age 35-50 years, family history of hypertension, ART duration, low CD4 count, and BMI ≥25kg/m2. As a result, health education on the significance of keeping a healthy lifestyle can be effective in preventing and treating hypertension in HIV patients.